Monday, April 8, 2013

This past month, I had the awesome privilege of observing an area of Speech Pathology that I don’t see too much of in the schools: Voice Disorders, or more specifically, Spasmodic Dysphonia. Spasmodic Dysphonia (SD) is a neurological disorder which causes tremors in the vocal folds, causing a breathy vocal quality. There is no known cause for SD and no cure. The most common treatment is Botox injections directly into the vocal folds, which paralyze tremors, removing the breathiness.

My grandmother has had Spasmodic Dysphonia (SD) for over 33 years. She was a voice major in college and sang in every venue possible. When she was around the age of 40, she noticed a hoarseness in her voice that wouldn’t go away.She went to many doctors who suggested it might be all kinds of things, from allergies, to vocal nodules, to even a psychological disorder brought on by stress. Nothing they suggested ever worked. Over time, her voice became much worse. She currently speaks in a very strained whisper and is unable to sing or variate her pitch much at all. About ten years ago, she read an article in Readers Digest about the author of the comic Dilbert, who had been diagnosed with Spasmodic Dysphonia and received Botox injections for treatment. She did a little research and self-diagnosed herself with SD.However, their income was very low, and she was too young for Medicare. She knew she couldn’t pay for treatment, so she never tried. Fast forward about eight years, and I was in my senior research class for my Bachelor’s degree in Speech Pathology. I decided to do my research project on my grandmother. I recorded her during different times of the day, during different types of weather, and while under the influence of alcohol. I then analyzed the recordings in the voice lab, and determined that the time of day and the weather made no difference with the amount of breaks, tremors, or extended moments of breathiness in her voice.Interestingly enough; however, the results did indicate that the alcohol made her voice worse. (A direct contrast to current premature research, although there was no research of this nature at the time of my study).

Last spring, she underwent several medical procedures which sent her back to a doctor since the last time she had birthed a child. The doctor recommended that she go to an ENT, which she agreed to do. The local ENT looked at her vocal folds through a scope and determined that there was nothing wrong with her vocal folds. (I was admittedly shocked at this news, as I figured she would have terrible nodules from straining so hard to talk through the years.) The ENT also thought she had SD, and he referred her to the Emory Voice Clinic in Atlanta for additional testing and possibly treatment. I was thrilled when she agreed to go (now that Medicare had kicked in) and that she wanted me to come along!

When we arrived at the Emory Voice Clinic, we were greeted by one of the six SLPs on staff. She had my grandmother do some readings (remember the Rainbow passage, anyone?), variate her pitch, hum, sing, and blow bubbles through a straw into a cup of water while humming. She then conducted a nasoscopy so she could see the vocal folds and the other structures and functions. While waiting on the doctor to come in, she also took my grandmother through some voice therapy exercises. Though my grandmother could not notice any change, the SLP and I noticed a change in her voice quality only after about 5 minutes!

The doctor then arrived to look over the nasocsopy results. He and the SLP explained that while she definitely has Spasmodic Dysphonia, there was something else going on as well. He explained to me that the second problem they spotted was why she never developed any vocal nodules, even though she strained to talk for some many years. Apparently, my grandmother had been subconsciously trying to compensate for the breathiness, and had been squeezing her muscles so tightly above her vocal folds, that the vocal folds were unable to open enough to allow voicing to occur. (This was evident from the scope because her muscles were squeezed so tightly that her false vocal folds were hidden.) So in addition to having SD, the compensation she was doing was cutting off her voice even further. The good news is that she is a prime candidate for Botox injections, and the Dr. and SLP were confident that the Botox injections would make a difference in her voice. They also recommended voice therapy with relaxation techniques as well.

UPDATE: Two weeks after my grandmother’s consultation visit at the Emory Voice Center, she returned to have her first round of Botox injections. They started her off on the smallest dose the give, explaining that over the next several months, they would determine the exact amount that works best for her. The Dr. and SLP had her do relaxation techniques before receiving the injections. They then explained that for the first couple of weeks after injections, she would be even more breathy than usual. Then her voice would begin to return, and usually around weeks 4-5 the Botox is at its prime. Two weeks had passed since her first injections when I saw her on Easter weekend. I couldn’t believe that I could actually hear a change! Not only was her voice louder and steadier than I had ever heard her, but I could also see how relaxed her throat muscles were because she wasn’t straining so hard. She could also tell a difference and noted how much easier it was for her to talk. She will return back in a few weeks for a follow-up appointment, but we can only hope that this was the start to something great and that her voice quality will only continue to improve!

I’ll be sure to keep everyone updated, but I wanted to share this great experience with everyone! So far, our experience with the Emory Voice Center has been wonderful. Do you know anyone who has Spasmodic Dysphonia?